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SAM-eCourtesy of The Mood Disorders Support Group of New York City |
This special topic page brings together information about SAM-e from assorted sources. For other depression related stories in the news, go to the main news page. If you know of an article in the media or links that might be included here, feel free contact our webmaster using the E-mail address at the bottom of this page.
| Introduction to SAM-e |
SAM-e (pronounced "Sammy") is the commonly used name for S-Adenosyl-Methionine. SAM-e occurs in every living cell and takes part in several biological reactions in the human body. It is thought to be effective for depression and arthritis.
The interest in SAM-e as an antidepressant stems from the fact that it seems to have fewer side effects than some other antidepressants and works relatively quickly. Although studies of SAM-e have been done, it has not been subjected to an FDA sanctioned double-blind, placebo-controlled study with published results. All the prescription antidepressants have been studied in such a way. No such study is currently underway.
Despite being available in Europe for twenty years, it was only introduced to the US in February 1999. SAM-e was the hottest-selling dietary supplement in the United States in 1999. In Europe it is known as "SAMe", but to avoid people pronouncing it "same", the name was changed to SAM-e when it was brought to the US.
SAM-e is sold as a prescription drug in Europe, however, in the US it is available over the counter. It is sold here as a dietary supplement and as such is not regulated by the Food and Drug Administration (FDA). Product labels for dietary supplements can make no overt health claims to treat anything. Because it is not regulated, there are significant differences among the types of SAM-e on the market. The American Medical Association has come out in favor of increased regulations for dietary supplements. In one study of St. John’s Wort, various brands were found to contain anywhere from 5 percent to 250 percent of the amount of active ingredient claimed on the label.
Despite the fact that you can purchase SAM-e over-the-counter, professional help is highly recommended for (among other things): determining dosage levels, information on the types and forms of SAM-e and judging the severity of a depression. In addition, like all antidepressants, it may trigger mania. The Depression Central web site has a list of psychiatrists in the USA that specialize in the treatment of mood disorders. US News and World Report magazine has a list of the best psychiatric hospitals.
| Lecture on SAM-e |
Dr. Richard P. Brown lectured to MDSG about SAM-e in October 1999. Dr. Brown is an Associate Professor of Clinical Psychiatry at Columbia University College of Physicians and Surgeons. He is a psychopharmacologist specializing in depressions resistant to conventional drug therapy. He has prescribed SAM-e for hundreds of patients and in June 1999 his book on SAM-e was published (see below). Dr. Brown is quoted in many of the articles in the media described below.
Among the points Dr. Brown made in his lecture are:
| Newsletter Articles on SAM-e |
by Betsy Naylor (from the May 1999 issue of our newsletter)
In mid-March a new alternative to prescribed antidepressants called SAM-e (sammy) began to appear on the shelves of GNC, CVS and even K-Mart. Its virtues? It goes into effect quickly-often in several days to a week-and its's thought to have few side effects.
Sam-e an acronym for S-adenosyl-methionine, is a natural compound found in every human cell and involved in over 35 biochemical processes in the body. It is possible to have too little SAM-e, and a low blood level has been correlated with depression. Discovered in 1952, SAM-e has been studied for 20 years and has been used for treating depression and osteoarthritis in Europe. For those who have not been responded to several antidepressants, SAM-e may be an option. It is not related chemically to other antidepressants.
At this time, there are no plans to submit SAM-e for FDA approval. This requires huge amounts of money for several years of clinical trials and is not financially viable to BSAF, the company that bought the U.S. patent. Without FDA approval, a package of SAM-e cannot list drug claims nor can it advise the amount to take.
Some psychiatrists worry that people will buy SAM-e over the counter and take it without being monitored by a physician. Bipolar patients are advised to take SAM-e only under medical supervision to insure that their mood does not go up too fast or too far. Unfortunately, SAM-e is expensive and is not covered by medical insurance. A 20-pill supply of Pharmavite's Nature Made costs about $25 in many stores.
To the Editor: (this letter to the editor is from
the August 1999 issue of our newsletter)
I wish you had included more about SAM-e (June issue 1999, No. 3),
especially the dose. Keeping us waiting until October (October 11 lecture by Dr. Richard
P. Brown on SAM-e) for that information is a real tease. I've heard the dose for
depression is supposed to be about 1200 mg, a day, but this information came from the
health store and is not necessarily reliable. Another point--I have taken SAM-e, and it
does cause a side effect: delayed orgasm, just like the SSRIs. I wouldn't be surprised if
SAM-e is a serotonergic drug but you don't say.
[name withheld]
Editor’s Reply:
Dr. Richard P. Brown, a Columbia University psychiatrist and author of
a new book on SAM-e (Stop Depression Now—see review this issue), said he
recommends 400 mg a day for mild depression and 800 to 1600 mg a day for "serious
depression." However, he is quick to add that those in the latter category should see
an M.D. for treatment. As for side effects, he said loose bowels and headache rarely
occur. He added that his patients have not complained of sexual dysfunction.
| SAM-e In The News |
Newsweek Magazine. December 2, 2002 issue. For those suffering from the pain of anxiety and
depression, complementary medicine is no miracle cure. But some treatments offer real hope.
Agency for Healthcare Research and Quality (AHRQ) issued an Evidence Report/Technology Assessment on using SAM-e for the Treatment of Depression, Osteoarthritis, and Liver Disease. The objective of the report is to conduct a search of the published literature on the use of SAMe for the treatment of osteoarthritis, depression, and liver disease; and, on the basis of that search, to evaluate the evidence for the efficacy of SAMe. August 2002.
December 2000 issue of Consumer Reports Magazine. This article discusses St. John's Wort, SAM-e and Kava. It says that SAM-e and St. John's Wort will not elevate the mood of a normal person and warns that self-treatment for depression can be dangerous. It cites the lack of strict government control over the content of SAM-e pills as a reason that many physicians haven't been recommending it. The magazine tested 12 brands of SAM-e and fully reported their findings. The findings include the fact that 8 brands had more SAM-e than claimed on the label and 4 brands had less. Only 6 of the 12 brands were enteric coated, an important attribute. The cost of a daily dose of 400mg of SAM-e ranged from $1.80 to $8.75. They also found some labels ambiguous and misleading. Finally, the article mentions a new clinical study of SAM-e where it was found to have the same effectiveness as imipramine, but with fewer side effects. Most articles from Consumer Reports are not available for free on their web site. To read the story on-line requires a paid subscription to the Consumer Reports web site.
March 28, 2000. This web page presents results of lab tests conducted
on 13 brands of SAM-e to see what the pills really
contain.
The company that conducted these tests, ConsumerLab.com
was featured in a story in the New York Times on June 20, 2000 called Putting
Dietary Supplements to the Test written by Clara Hemphill. They make an important point about SAM-e product labels
and how some brands that appear to have (for example) 200mg of SAM-e really
contain 100mg of SAM-e and 100mg of a stabilizing compound. They found that 6 out of 13 of the
products " did not pass testing". The web page lists eight brands that
passed the tests, but not the brands that failed. They also issued a
press release about the test results.
This story was also covered on the WebMD site: Some SAMe Supplements Found Lacking.
About Half Had Less of the Active Ingredient Than Labels Implied. By Jim Morelli, RPh.
WebMD Medical News. March 29, 2000.
February 7, 2000. NBC Nightly news with Tom Brokaw did a story on SAM-e in conjunction
with Good Housekeeping Magazine. On the pro side, they profiled a woman who was helped by
SAM-e. On the con side, Dr. Robert Packman of Washington University said: "What I
think is actually happening in the case of SAM-e is that we’re really seeing a
placebo response." Like the article from Better Homes and Gardens Magazine
below, they warned about how the pills don't necessarily match the labels on the outside
of the SAM-e box. The Good Housekeeping lab tested 8 brands of SAM-e and found that 5 had
more SAM-e than the label claimed, 2 had less, and one brand had none at all.
(Note: this article has disappeared from the MSNBC web site).
What’s in your SAM-e?
February 4, 2000. Another NBC report on SAM-e and the Good Housekeeping
lab tests was done by WNBC in New York City. Their story notes that since SAM-e is sold in
the U.S. as a food supplements, it is not subject to the same rigorous testing as drugs.
In other countries SAM-e is sold by prescription. This story has more details on the lab
tests. Nature Made, Solgar, Nature’s Plus, GNC and Now had more SAM-e than stated on
the label; Aspen and Food Science of Vermont had less. Nature’s Vision had none.
(Note: this article has disappeared from the MSNBC web site).
February 2000. Better Homes and Gardens Magazine. SAMe, an over-the-counter antidepressant, is a hug seller, but does it really work? Topics in the article include: Is it too good to be true?, How SAMe works, Side effects, Buyers beware and Diagnosing real depression. The Buyers beware topic says that SAMe is difficult to produce because the active ingredients are unstable. Dr. Richard Brown had a lab analyze eight major brands of SAMe and found that two brands contained no SAMe while others had less than half the amount claimed on the package. Dr. Brown recommends the GNC, Nature Made, Life Extension Foundation and Solgar brands. This article is not available on their web site, all they have on-line is a single question about weight gain with SAM-e.
On January 16, 2000, the NBC TV show Dateline did a story about SAM-e. Dr. Richard Brown was interviewed as part of the story. Unfortunately, nothing from the story seems to have made it to their web site. NBC sells transcripts through the Burrell Transcript Service at (800) 777-TEXT. Selected segments of their news magazines are available for purchase on VHS cassette by calling (800) 420-2626. Their email address is dateline@nbc.com
January 14, 2000. NBC News. Many people are discovering a relatively new dietary supplement on store shelves that promises to treat a number of things from depression to arthritis. However, doctors warn that the supplement, called sam-e, should be treated cautiously. Note: This story has disappeared from the MSNBC web site.
November 29, 1999. The Boston Globe. Judy Foreman. It's not at all clear how SAM-e
might combat depression. It does not work as Prozac-type drugs do, by blocking re-uptake
of serotonin. It may act by improving the elasticity of cell membranes or by stabilizing
receptors on cell membranes, but this is unproved. Still, there's evidence that some
depressed people may be low in SAM-e, and that taking SAM-e supplements may help. Several
studies suggest that SAM-e can boost serotonin levels. Other evidence suggests SAM-e may
also raise levels of dopamine and norepinephrine, two other brain chemicals often involved
in depression. Yet even psychiatrists who recommend SAM-e are cautious. Says one: "It
is not a good first-line drug. It's something to consider as a possible alternative when
other things have failed." The use of SAM-e may be appropriate for patients who can't
tolerate side-effects of other antidepressants. In order for the body to make SAM-e, a
person must have adequate levels of folate (which in turn is made from folic acid, a
vitamin) and vitamin B-12. (In fact, adding folate to standard antidepressants may
increase their benefit). If you try SAM-e, do so under a doctor's supervision, assuming
you can find a doctor open-minded enough to read what research is available.
October 1999 issue of Consumer Reports Magazine. Page 8.
This is a short article, less than a page, and mostly is an overview. It contains this
warning however: "At least 7 brands of SAM-e are sold in the US. There is no
guarantee that pills sold as SAM-e actually contain the compound and Consumer Reports has
not tested the products. The FDA has not studied dosages." Most articles from
Consumer Reports are not available for free on their web site. To read the story
on-line requires a paid subscription to the Consumer Reports web site.
August 16, 1999. Time
Magazine by TIME health columnist Christine Gorman.
If supplements were movies, same would be the sleeper hit of the summer. Introduced in the
U.S. in March, it is now the fourth most popular individual supplement in drugstore chains
and general retail outlets. The results of studies to date, though not definitive, are
intriguing enough so that several U.S. psychiatrists have started offering Sam-e, both in
addition to more conventional treatments and by itself. Even if Sam-e is not the wonder
cure its proponents claim, it so far appears to be safe. If you're suicidal or severely
depressed, get professional help. Don't try treating yourself with Sam-e on your own.
Alternate
link to same article.
August 10, 1999. USA Today. This article is an overview and introduction to SAM-e. It makes the point that you should not take SAM-e along with prescription drugs without a doctors guidance. In fact, it says that if you are self-treating a serious depression with SAM-e, you have a fool for a patient. The article compares SAM-e to St. John's Wort and notes that some brands of SAM-e contain more baby powder than SAM-e. The article points out that Dr. Richard Brown is not paid to endorse SAM-e and says the major drug companies are not delighted with him. It quotes him as saying "Most of what doctors do in the U.S. is determined by drug companies' advertising, and there is no big drug company behind this therapy." This article has disappeared from the USA Today web site.
July 5, 1999. Newsweek Magazine. Proponents claim that this hot new over-the-counter dietary supplement can ease
depression, restore arthritic joints and combat chronic liver disease. Here's what we know
about it - and what we don't.
The article says that although no one is sure exactly how SAM-e works for depression,
there is little question that it can help fight depression. Much is known however about
how SAM-e works in general and this is covered in detail in the article, including the
relationship of SAM-e to B vitamins. Without FDA approval, the article says few American
doctors will recommend SAM-e. This despite the fact that SAM-e is clearly less toxic than
prescription antidepressants. The article also compares SAM-e to St. John's Wort
and
discusses dosage levels for SAM-e and the two forms of SAM-e on the market (tosylate and
butanedisulfonate). This article has disappeared from the MSNBC web site which
is where Newsweek magazine resides.
March 22, 1999. Newsweek Magazine.
A new supplement may help relieve depression and arthritis as well.
According to the USA Today article from August 10, 1999 (see above) this article set off
much of the interest in SAM-e. It is a fairly short article compared to the longer
follow-up article that Newsweek ran on July 5, 1999 (see above). It says that SAM-e is
comparable to state-of-the-art treatments for both depression and arthritis. Established
depression drug treatments help about 70 percent of patients and in controlled studies
SAM-e also helped about 70 percent of the subjects. Dr. Richard Brown is quoted as saying
it is "the best antidepressant I've ever prescribed." The article says
that SAM-e aids in the production of dopamine and serotonin. Like other articles it
warns that SAM-e is not appropriate for the treatment of bipolar disorder because is can
exacerbate mania. This article has disappeared from the MSNBC web site which is
where Newsweek magazine resides.
March 1999. ABCNEWS.com. This article notes that SAM-e plays a role "in as many as 35 to 40 biochemical reactions throughout the body." It says "Usually the body can make all the SAMe it needs, but patients with depression and other conditions have been found to have lower levels of the compound." In discussing the studies that have been done comparing SAM-e to existing prescription antidepressants, this article is the only one to point out that SAM-e has been compared to tricyclics (such as Elavil, Norpramin, and Sinequan) but has never been studied relative to any of the SSRIs. It also discusses the risks involved in taking SAM-e without medical supervision.
THE BUZZ ABOUT SAM-E, THE LATEST HOT DIETARY SUPPLEMENT
August 8, 1999. It's much easier to find SAM-e at pharmacies than to track down
U.S. research on it. European research is mostly positive, using daily doses between 400
and 1,200 milligrams and showing few side effects. But one question mark is the quality of
the active ingredient in SAM-e; some products don't deliver an effective amount.
METABOLIC BOOSTER
Published on 04/09/99, (241 words). Joints a little achy these days? Feeling
depressed? Maybe your liver could use a little extra help defending itself against a daily
onslaught of toxins? "Sammy" may be your new best friend...
This article is not available for free on the newspapers web site. The paper charges $1.95
for each article retrieved from their archives. This article can be found by searching for
"SAM-e".
Note: Despite claiming to have an archive of articles going back to 1985, these
two articles have disappeared from the web site of the Chicago Tribute.
The articles above are not hosted on our web site and as such it is possible that the link could become invalid because the article has been moved or deleted. If any of the links above are no longer valid, please let our webmaster know via the E-mail address at the bottom of this page. Thank you.
| Links about SAM-e |
The National Center for Complementary and Alternative Medicine
(NCCAM)
If You're Depressed, Will SAM-e Help? There's Little Evidence to Support Supplement's Effectiveness. By Amy Rothman Schonfeld, Ph.D. WebMD Medical News. Reviewed by Dr. Jacqueline Brooks. August 2, 2000.
Any retailer has an inherent conflict of interest in reporting on a product they sell. The Whole Health Discount Center sells SAM-e on their web site, but their description includes important precautionary information that advises taking Vitamin B and C in conjunction with SAM-e. There are also extensive footnotes.
One of the SAM-e vendors, Nature Made, has a web site at www.naturemade.com. The following quote is from their web site: For more information about SAM-e call the toll-free Nature Made Healthline at 1-800-276-2878 and speak with a nutrition expert.
The Depression Central web site has the results of a MEDLINE search on the use of SAM-e for the treatment of depression.
SAM-e is also used to treat arthritis and at www.arthritis.org they have a brief overview of SAM-e.
| Books about SAM-e |
This book review by Betsy Naylor is from the August 1999 issue of our newsletter
Richard Brown M.D., Teodoro Bottiglieri Ph. D.,
and Carol Coleman
G.P. Putnam Sons, New York. June 1999. 267 pages.
Publication of this book coincided with the March 1999 release of SAM-e into the American market. The authors provide information about the chemistry of SAM-e (short for S-Adenosyl-Methionine), its clinical record, its efficacy and dosage.
A psychopharmacologist, Dr. Brown specializes in depressions resistant to conventional drug therapy. He has prescribed SAM-e for hundreds of patients. Because of its efficacy, it is often his drug of choice. In Italy, it outsells Prozac. Dr. Bottiglieri, a neurobiology and biochemistry research scientist, and perhaps the world’s foremost expert on SAM-e, has studied it for the past 15 years.
Discovered in 1952, SAM-e is found in every living cell, involved in more than 35 processes in the human body. It has been used to treat depression in Europe since the 1970s. The book cites many studies that support the claims made in the book title.
Because Dr. Brown believes strongly that patients should participate in their own care, he outlines four specific steps of an integrated plan for getting better. He suggests beneficial eating habits, exercise, aids to relaxation like yoga and meditation, and cognitive techniques for handling obsessive, destructive thought patterns. MDSG members probably know many of these techniques, but the review provides a helpful reinforcement and some new ideas.
SAM-e is now available over the counter. Stop Depression Now provides dosage information for those trying it without a doctor’s supervision. But these crucial warnings appear more than once: People who are seriously depressed and/or suicidal should seek professional help. People on an antidepressant should not stop taking it cold turkey and switch to SAM-e. Bipolars should take SAM-e only under medical supervision. Just like any other antidepressant, SAM-e can propel them into a manic episode.
Books by legitimate authors about new medications can sweep the reader along with their persuasive arguments. We remember only what we want to hear. Natural products are very appealing, especially when we read there are no side effects. Imagine--no weight gain, no sexual dysfunction, no caffeine effect, no gastrointestinal complaints!
But is this claim believable? Natural products are not necessarily harmless. (What about tobacco, opium, and strychnine?). And in scientific studies even people on placebos report side effects. SAM-e has been scientifically tested on a few thousand patients. Now that it’s easy to obtain here, millions may try it. Who knows what reactions will appear in the larger group?
Depression is complex, and no one substance helps every person. This book is valuable for those who have not improved on anything yet, and others who don’t or won’t seek psychiatric help. At least now these people can learn about SAM-e and its use, information previously unavailable to the general public.You can read more about the first edition of Dr. Brown's book and purchase it from Amazon.com by clicking here. As of December 2001, Amazon was selling it for $4.99. Their price can change at any time. You can read more about the second edition (September 2000) of the book by clicking here. As of December 2001, Amazon was selling it for $9.60. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you.
The Fast, Natural Way to Overcome Depression, Relieve the Pain of Arthritis, Alleviate the Discomfort of Fibromyalgia, and Boost Your Energy. By Nancy Stedman. Published December 2000. Quoting from the author about the book: "The SAM-e Handbook is a thorough introduction to the supplement. It weighs the evidence of SAM-e's effectiveness and answers many practical questions not addressed by other books on the subject: Who is most likely to benefit from SAM-e? Who should steer clear of it? What doses are best for different problems? Which are the best brands of SAM-e-and which are out-and-out frauds? Where can you get the lowest prices? And how do you find a doctor who will help you use SAM-e effectively?".
You can read more about this book and purchase it from Amazon.com by clicking here. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. There are 25 sample pages available online. As of December 2001, Amazon was selling it for $9.95. Their price can change at any time.
by Dallas Clouatre Published September 1999. 96 pages. You can read more about this book and purchase it from Amazon.com by clicking here. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. There are 11 sample pages available online. As of December 2001, Amazon was selling it for $2.99. Their price can change at any time.
by Sol Grazi, Marie Costa Published January 1999. 256 pages. You can read more about this book and purchase it from Amazon.com by clicking here. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. There are 11 sample pages available online. As of December 2001, Amazon was selling it for $11.20. Their price can change at any time.
by Craig Cooney, Bill Lawren (Contributor). Published May 1999. Most of the articles linked to above discuss the process by which SAM-e works, methylation. This book is mentioned in the July 5, 1999 article in Newsweek magazine. You can read more about this book and purchase it from Amazon.com by clicking here. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. There are 11 sample pages available online. As of December 2001, Amazon was selling it for $18.36. Their price can change at any time.
by Deborah Mitchell. Published October 1999. 144 pages. The publisher has a web page with information about this book. On their web site, the publisher describes the author as: "a medical writer and journalist specializing in complementary medicine and nutrition topics." You can read more about this book and purchase it from Amazon.com by clicking here. Purchases made this way result in a referral fee being paid by Amazon to MDSG at no cost to you. There are 29 sample pages available online. As of December 2001, Amazon was selling it for $8.99. Their price can change at any time.
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